["Secondary surgery" in the oncologic concept of malignant struma]

Between 1978-1987 a reoperation had to be performed on 115 patients with carcinoma of the thyroid gland due to oncologically inadequate initial surgery. In papillary carcinomas, the high percentage of T1-tumors (43.1%) were the reason for lack of prae- or intraop. diagnostic evaluation, with the follicular carcinomas the high percentage of borderline frozen section. With invasive carcinomas, residues of the tumor were found either in the remaining thyroid tissue or in the lymph nodes (20.8%) while no further tumor has been found in encapsulated carcinomas. The rate of recurrent nerve paralysis document right after reportation was 18%, and its frequency depended on the time interval between initial surgery and reoperation. With encapsulated carcinomas of the type T1 we would suggest not to consider a reoperation, because we do not expect intrathyreoidal metastasation nor tumor involved lymph nodes and the risk of causing a recurrent nerve paralysis by a reoperation is not justifiable.